Refractory antibody-mediated rejection after high-emergency lung transplantation for dermatomyositis with anti-MDA5...

This case report describes a female with amyopathic anti-MDA5+ dermatomyositis who underwent emergency double lung transplantation due to rapidly progressive interstitial lung disease. Following transplantation, she developed acute antibody-mediated rejection (AMR). Despite multiple rounds of immunosuppressive therapy, her condition continued to deteriorate, and her donor-specific anti-human leukocyte antigen antibody levels increased markedly. An experimental treatment, imlifidase-an immunoglobulin G endopeptidase-was employed as a rescue therapy. This case highlights the complexity of posttransplant management of AMR and emphasizes the need for dedicated clinical trials to provide additional data.